INFLUENCE OF INFANT FEEDING PRACTICE ON THE NUTRITIONAL STATUS OF 6-59 MONTHS CHILDREN OF SUKUMBASHI BASTI, KANKAI MUNICIPALITY JHAPA by Devi Khadka Department of Nutrition and Dietetics Central Campus of Technology Institute of Science and Technology Tribhuvan University, Nepal August, 2019 i Influence of Infant Feeding Practise on The Nutritional Status of 6-59 months Children of Sukumbashi Basti, Kankai Municipality, Jhapa A dissertation submitted to the department of nutrition and dietetics, Central Campus of Technology, Tribhuwan University, in the partial fulfillment of the requirements for the bachelor degree in Nutrition and Dietetics by Devi Khadka Department of Nutrition and Dietetics Central Campus of Technology Institute of Science and Technology Tribhuvan University, Nepal August, 2019 ii Tribhuvan University Institute of Science and Technology Department of Nutrition and Dietetics Central Campus of Technology, Dharan Approval Letter The dissertation entitled “Influence of Infant Feeding Practise on The Nutritional Status of 6-59 months Children of Sukumbashi Basti, Kankai Municipality, Jhapa” presented by Devi Khadka has been accepted as the partial fulfillment of the requirement for the bachelor degree in Nutrition and Dietetics. Dissertation Committee 1. Head of the Department ………………………………………… (Dambar Bahadur Khadka, Asst. Prof) 2. External Examiner ………………………………………… ( Prof. Dr. Surendra Bahadur Katwal) 3. Supervisor .………………………………………… (Arjun Ghimire, Asst Prof.) 4. Internal Examiner .………………………………………… (Kabindra Bhattarai, Lecturer) August, 2019 iii Acknowledgement I would like to express my profound sense of gratitude to my respected guide Mr. Arjun Ghimire (Assistant Professor, Central Campus of Technology, Dharan) for his excellent guidance, useful suggestion and proper encouragement during the course of this work. Also, I would like to thank Prof Dr. Dhan Bahadur Karki, Campus Chief, Central Campus of Technology for enormous support. I am also grateful to Mr. Dambar Bahadur Khadka, Head of Nutrition and Dietetics Department, Central Campus of Technology. I am extremely thankful to him for sharing expertise, and suggestions and valuable guidance and also providing me with all the facilities for the research. I cannot forget valuable support of my friends (Saurav Khadka, Anuj Karki and Binod Niroula) in every step for the preparation of this dissertation. I am indebted to my friends Anita Karki, Rakshya Ghimire and Chandrika Dangal for sincere efforts in data collection. I am thankful to my friends Muna Basnet, Diwas Jimee, Pankaj Koirala, Anjesh Poudel for their support in my thesis writing. I am thankful to my classmates who supported me throughout the course of study. Finally, my deepest gratitude to my respected parents and family for their enormous support, love and making me believe in myself. Date of Submission: August, 2019 ………………… Devi Khadka iv Abstract A nutritional survey was conducted among the 6–59 months of children residing in Sukumbashi basti, Kankai Municipality. Anthropometrics measurements along with household surveys were carried to find out the level of malnutrition and information about the feeding practice. Random sampling with 123 samples was taken for the study and the data collected were analyzed by using SPSS version 20 and WHO anthro 3.2.2 version. The study show that 6.5% were found to be wasted out of which no were found to be severely wasted. Similarly, 26.8% were found to be stunted out of which 1.6% were found to severely stunted and 9.7% of the children were found to be underweight, out of which 0.8% were severely underweight. The factor significantly associated with stunting (p≤0.05) were exclusive breastfeeding, starting of complementary feeding, pulses intake with 3-5 times per week and source of drinking water from river. Similarly, the factor significantly associated with wasting (p≤0.05) were exclusive breastfeeding, duration of breast feeding, types of complementary jaulo, and source of drinking water from river and the factor significantly associated with underweight at (p≤0.05) were exclusive breastfeeding, types of complementary and pulses intake per week. This indicates that under nutrition is still an important problem among 6 to 59 months children of Sukumbashi basti, Kankai municipality, Jhapa. v Contents Approval Letter iii Acknowledgement iv Abstract v Contents vi List of Tables ix List of figures x List of abbreviations xi Part I: Introduction 1 1.1 General introduction 1 1.2 Statement of problem and justification 2 1.3 Objectives of the study 3 1.3.1 General objectives 3 1.3.2 Specific objectives 3 1.4 Research questions 3 1.5 Significance of study 3 1.6 Limitation of study 4 1.7 Conceptual framework 4 Part II: Literature Review 5 2.1 Background 5 2.2 Nutrition status 5 2.2.1 Factor affecting the nutritional status 6 2.3 Food availability and nutritional status 8 2.4 Malnutrition 8 2.5 Types of Malnutrition 9 2.5.1 Most common malnutrition problems 10 2.5.1.1 Protein energy malnutrition (PEM) 11 2.5.1.2 Iron deficiency Anemia 13 2.5.1.3 Iodine deficiency disorder 14 2.5.1.4 Vitamin-A deficiency 14 2.5.1.5 Zinc deficiency 15 2.6 Causes of malnutrition 15 2.6.1 Dietary intake 15 vi 2.6.2 Low birth weight and maternal nutritional status 16 2.6.3 Breastfeeding practices 16 2.6.4 Complementary feeding practices 17 2.6.5 Disease, sanitation, and hygiene and access to health care 17 2.6.6 Poverty and food security 17 2.6.7 Gender inequality and women‟s status 18 2.7 Appropriate Infant and Young Child Feeding Practices 18 2.7.1 Breastfeeding 18 2.7.1.1 Nutritional benefits of breast milk 20 2.7.2 Colostrum 21 2.7.2.1 Importance of colostrum 21 2.7.3 Complementary Feeding 22 2.7.3.1 Importance of complementary feeding 22 2.8 Assessment of Nutritional Status 23 2.8.1 Direct method 23 2.8.2 Indirect method 23 2.8.3 Ecological factors 23 2.9 Anthropometric measurement 23 2.9.1 Height for age 24 2.9.2 Weight for height 24 2.9.3 Weight for age 24 2.9.4 MUAC (Mid Upper Arm Circumference) 25 Part III: Materials and Methods 26 3.1 Research instrument 26 3.1.1 Weighing machine 26 3.1.2 Height measuring scale 26 3.1.3 Mid Upper Arm Circumference (MUAC) 26 3.1.4 Set of questionnaire 27 3.2 Research design 27 3.3 Study area 27 3.4 Study variable 28 3.5 Target population 28 3.5.1 Inclusion criteria 28 vii 3.5.2 Exclusion criteria 28 3.6 Sampling techniques 28 3.7 Sample size 29 3.8 Pre testing 29 3.9 Validity and reliability 29 3.10 Data collection technique 30 3.11 Data analysis 30 3.12 Logistical and ethical consideration 30 Part IV: Results and Discussion 31 4.1 Socio-economic and demographic characteristics 31 4.2 Child characteristics 33 4.3 Maternal characteristics 35 4.4 Child feeding and care practices 36 4.5 Personal hygiene and environment sanitation 39 4.6 Prevalence of malnutrition 40 4.6.1 Distribution of malnutrition based on gender 42 4.6.2 Distribution of malnutrition based on MUAC 43 4.6.3 Nutrition status comparison with WHO standard 43 4.6.4 Edema 48 4.7 Factors associated with under nutrition 48 4.7.1 Factors associated with stunting 48 4.7.2 Factors associated with wasting 51 4.7.3 Factors associated with underweight 54 Part-V: Conclusion and Recommendation 57 5.1 Conclusion 57 5.2 Recommendation 57 Part VI: Summary 58 Reference 59 Appendix A: Informed Consent 67 Appendix B: Questionnaire 68 Appendix C: Photo Gallery 73 Appendix D: MAP 74 viii List of Tables Table no Title Page Table 4.1: Distribution of the surveyed population according to demographic characteristics (n=123) 31 Table 4.2: Distribution of the surveyed population according to socio-economic characteristics (n=123) 32 Table 4.3: Distribution of the surveyed population according to child characteristics(n=123) 34 Table 4.4: Distribution of the surveyed population according to maternal characteristics(n=123) 35 Table 4.5: Distribution of the surveyed population according to child feeding (n=123) 36 Table 4.6: Distribution of the surveyed population according to child caring practice(n=123) 37 Table 4.7: Food frequency distrubution (n=123) 38 Table 4.8: Distrubution of samples based on personal hygine and environmental sanitation (n=123) 39 Table 4.9:Gender wise distribution of wasting, stunting and underweight (n=123) 40 Table 4.10: Distribution of malnutrition based on MUAC (n=123) 42 Table 4.11: Factors associated with stunting in under five children of Sukumbashi basti, Kankai Municipality (n=123) 43 Table 4.12: Factors associated with wasting in under five children of Sukumbashi basti, Kankai Municipality (n=123) 50 Table 4.13: Factors associated with underweight in under five children of Sukumbashi basti, Kankai Municipality (n=123) 53 ix List of figures Figure no. Title Page Fig 1.1: UNICEF conceptual framework 4 Fig 4.1: Prevalence of under nutrition in the study area in comparison to NDHS 2016, 41 Fig 4.2:Gender wise distribution of stunting, wasting and underweight 43 Fig 4.3: Distribution of stunting among 6 to 59 months children of Sukumbashi basti based on WHO standard (n=123) 44 Fig 4.4: Distribution of underweight among 6 to 59 months children of Sukumbashi basti based on WHO standard (n=123) 45 Fig 4.5: Distribution of wasting among 6 to 59 months children of Sukumbashi basti based on WHO standard (n=123) 46 Fig 4.6: Distribution of BMI for Age among 6 to 59 months children of Sukumbashi basti based on WHO standard (n=123) 47 Fig 4.7: Distribution of malnutrition based on MUAC among 6 to 59 months‟ children of Sukumbashi basti based on WHO standard (n=123) 48 x List of abbreviations Abbreviations Full form ARI Acute Respiratory Infection BMI Body Mass Index EBF Exclusive Breastfeeding IgA Immunoglobulin A IYCF Infant and Young Child Feeding LBW Low Birth Weight MUAC Mid Upper Arm Circumference NDHS Nepal Demographic Health Survey ORS Oral Rehydration Solution PEM Protein Energy Malnutrition PSTI Pancreatic Secretory Trypsin Inhibitor UNICEF United Nation International Children‟s Emergency Fund VDC Village Development Community WFP World Food Program WHO World Health Organization xi Part I Introduction 1.1 General introduction Nutrition is the intake of food, considered in relation to the body‟s dietary needs.